Role of transvaginal ultrasound-guided biopsy in gynecology

Abstract

BackgroundUltrasound-guided biopsy is an easy technique for obtaining tissue samples. It is commonly used for different types of tumors, such as breast and prostate cancers, in order to plan early and adequate treatment.ObjectiveTo evaluate the indications, adequacy, and safety of transvaginal ultrasound-guided biopsy in women with pelvic lesions suspected of gynecologic malignancy.MethodsA retrospective study including all patients who had undergone transvaginal ultrasound-guided biopsy between April 2015 and May 2018 was carried out at the division of gynecologic oncology. Inclusion criteria were the presence at imaging of abdominal or pelvic tumors in patients considered not ideal candidates for primary gynecological surgery, or the origin and/or nature of the tumor was unclear and further management required histological verification. Patients with planned surgery were excluded from the study. Transvaginal biopsies were performed with a 18 G/25 cm core-cut biopsy needle and histology was obtained. Tru-cut biopsies were performed using an automatic bioptic gun with a 18 G/25 cm core-cut biopsy needle. Results are presented as absolute frequency (percentage) for nominal variables and as median (range) for continuous variables.ResultsA total of 62 women were analyzed. An adequate sample for histological analysis was obtained in all cases. Histopathological examinations showed 24 (38.7%) benign lesions (fibrosis, inflammation, uterine or ovarian myoma) and 38 (61.3%) malignant tumors, distributed as follows: 34 (89.5%) malignant gynecological lesions and 4 (10.5%) non-gynecological malignant tumors. Among the malignant lesions, there were 12/38 (31.6%) primary tumors, 24/38 (63.2%) recurrent tumors, and 2/38 (5.3%) metastases from non-genital cancer. Ten patients eventually underwent surgery. Final histology was not in agreement with the results from transvaginal ultrasound-guided biopsy in 2 of 10 patients (20%); in particular, benign disease at transvaginal ultrasound-guided biopsy was malignant at final histology (two cases of recurrence of cervical cancer). Three patients (4.8%) had pain during the procedure, which was controlled by oral analgesic therapy and lasted for no longer than 10 min. No major complications were registered.ConclusionsTransvaginal ultrasound-guided biopsy is a minimally invasive method to obtain adequate material for histological diagnosis and could avoid unnecessary surgical procedures, costly CT-guided procedures, or prolonged waiting times.

Transvaginal Ultrasound-Guided Core Biopsy—Experiences in a Comprehensive Cancer Centre

“…The calculated NPV was 80%, which might raise awareness: in case of clinical suspicion of malignancy, surgical exploration is suggested despite a negative biopsy result, as false negativity cannot be ruled out. This performance is similar to the literature previously reported; however, to the best of our knowledge, this study is the largest comparison between the transvaginal biopsy and surgical histological results [ 1 , 18 , 19 ]. Due to the heterogeneity of many gynaecological tumours, we believe a core biopsy might be advantageous over a fine needle aspiration biopsy because it provides more detailed information about tissue structure.…”

“…Histological diagnosis of female pelvic tumours is essential in their adequate and early clinical management. Ultrasound-guided biopsy is a routine diagnostic method to obtain tissue samples and used widely in different types of tumours [ 1 , 2 , 3 ]. Pelvic solid masses can be biopsied via transabdominal, transvaginal, transrectal or transperineal routes [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ].…”

“…Pelvic solid masses can be biopsied via transabdominal, transvaginal, transrectal or transperineal routes [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. Generally, lesions located deep within the female pelvis are not easy to access transdabdominally due to various bowel loops, major vessels, uterus, urinary bladder and ureter being in the path of the needle [ 1 , 11 , 12 ]. In contrast, the transvaginal and transrectal approaches may provide a safer pathway for biopsy sampling, avoiding injury of the critical organs [ 12 , 13 , 14 , 15 ].…”

“…Diagnostic laparoscopy or explorative laparotomy is commonly performed to obtain definitive histological diagnoses in gynaecological cancer patients. In recurrent gynaecological cancer patients or primary advanced-stage ovarian cancer patients, surgery is no longer advocated if optimal cytoreduction is not feasible [ 1 , 22 ]. In general, ultrasound-guided CNB provides a less invasive way to obtain tissue samples for diagnosis, avoiding much greater invasiveness of laparoscopic or open surgical biopsy [ 14 , 16 , 23 , 24 ].…”

Factors Influencing the Discordancy Between Intraoperative Frozen Sections and Final Paraffin Pathologies in Ovarian Tumors

“…Needle aspiration and image-guided core biopsy are widely used for a variety of the other non-ovarian tumors, such as breast cancer, without adverse impact on prognosis ( 13 ). However, needle aspiration or core biopsy is less common clinical practice in the diagnosis of ovarian tumors, because these two procedures pose the risk of spillage and possible upstaging of malignant lesions ( 13 , 14 ).…”